Sourav Das

Hindi translation of Berlin questionnaire and its validation as a screening instrument for obstructive sleep apnea

Background: Obstructive sleep apnea (OSA) is a fairly common problem with adverse health consequences. However, any screening questionnaire is not available in Hindi to screen sleep apnea. Materials and Methods: Subjects undergoing video-synchronized in laboratory attended polysomnography were requested to participate in this study. They were screened with the help of Hindi version of Berlin questionnaire (BQ). Outcome of the BQ was tested against the gold standard polysomnography. Descriptive statistics, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of Hindi version were calculated. Results: 38 patients with polysomnography diagnosed OSA and 12 controls were included in this study. Average body mass index (BMI) in the OSA group was 33.12 + 6.66 kg/m2 whereas in the control group BMI was 25.01 + 4.20 kg/m2. Average age in the OSA group was 48.9 + 10.2 years whereas the control group was older (56.9 + 12.1 years). Hindi version had sensitivity of 89% and specificity of 58%. PPV of the instrument was 0.87 whereas NPV was 0.63. Conclusion: Hindi version of BQ is a valid tool for screening the OSA irrespective of the literacy status of the subjects.

Hindi translation and validation of Cambridge-Hopkins Diagnostic Questionnaire for RLS (CHRLSq).

Background: Restless legs syndrome also known as Willis-Ekbom′s Disease (RLS/WED) is a common illness. Cambridge-Hopkins diagnostic questionnaire for RLS (CHRLSq) is a good diagnostic tool and can be used in the epidemiological studies. However, its Hindi version is not available. Thus, this study was conducted to translate and validate it in the Hindi speaking population. Materials and Methods: After obtaining the permission from the author of the CHRLSq, it was translated into Hindi language by two independent translators. After a series of forward and back translations, the finalized Hindi version was administered to two groups by one of the authors, who were blinded to the clinical diagnosis. First group consisted of RLS/WED patients, where diagnosis was made upon face to face interview and the other group - the control group included subjects with somatic symptoms disorders or exertional myalgia or chronic insomnia. Each group had 30 subjects. Diagnosis made on CHRLSq was compared with the clinical diagnosis. Statistical Analysis: Analysis was done using Statistical Package for Social Sciences (SPSS) v 21.0. Descriptive statistics was calculated. Proportions were compared using chi-square test; whereas, categorical variables were compared using independent sample t-test. Sensitivity, specificity, and positive predictive value of the translated version of questionnaire were calculated. Results: Average age was comparable between the cases and control group (RLS/WED = 39.1 ± 10.1 years vs 36.2 ± 11.4 years in controls; P = 0.29). Women outnumbered men in the RLS/WED group (87% in RLS/WED group vs 57% among controls; χ2 = 6.64; P = 0.01). Both the sensitivity and specificity of the translated version was 83.3%. It had the positive predictive value of 86.6%. Conclusion: Hindi version of CHRLSq has positive predictive value of 87% and it can be used to diagnose RLS in Hindi speaking population.

Clinical Practice Guidelines for Sleep Disorders

S116 is a common complaint with a number of Psychiatric disorders e.g., depression, anxiety, and withdrawal from the substances that depress cerebral functioning. In addition, we now have evidence that link the depression, bipolar disorder and schizophrenia with the disordered circadian rhythms and many of these patients show delayed sleep wake phase cycle.Similarly, antidepressants are known to induce a number of sleep disorders including NREM parasomnias (sleep talking, sleep walking) as well as REM parasomnias (REM sleep behavior disorder) and restless legs syndrome.Antipsychotics may cause weight gain and thus they may lead to obstructive sleep apnea in a number of patients.Similarly, opioid users suffer from central sleep apnea and during withdrawal many of them develop RLS. Both these conditions may worsen the quality of the sleep.

Opioid withdrawal presenting as delirium and role of buprenorphine: A case series

Opioid withdrawal is very rarely characterized by delirium unlike alcohol or benzodiazepine withdrawal. PubMed search through October 2016 reveals only two case series on delirium as feature of withdrawal in opioid dependence syndrome. We report two cases of opioid withdrawal (heroin) presenting with delirium when low-dose buprenorphine (2 mg/day) was added. Both the cases had no other substance abuse history and nil contributory past and family history. Both of them were improved after increasing the buprenorphine dosage to 6–8 mg/day. The possibility of delirium as a part of withdrawal symptom or as a phenomenon induced by buprenorphine or due to impurities in the heroin used is discussed.

Role of Sleep Aids and Wake-Promoting Agents During Cognitive Behavior Therapy for Insomnia

Purpose of ReviewCognitive behavior therapy is known to be the treatment of choice for chronic insomnia while pharmacotherapy is the preferred approach for short-term insomnia. Combined approach has been found useful in other disorders like major depressive disorder. However, literature that has assessed efficacy of combination of pharmacotherapy and cognitive behavior therapy in insomnia is limited. This review tries to explore the utility of combined treatment in the background of pathophysiology of insomnia.Recent FindingsLiterature search suggested that most of the patients suffering from insomnia have hyperarousal both at night and during the daytime. Cognitive behavior therapy for insomnia reduces the hyperarousal and promotes sleep. However, addition of hypnotic agents that are known to reduce hyperarousal improves the compliance as well as efficacy of cognitive behavior therapy for insomnia. A subset of patients with insomnia may have daytime fatigue and stimulant medications, e.g., modafinil may help these patients to improve their functioning.SummarySleep-promoting agents as well as wake-promoting agents are important during cognitive behavior therapy for insomnia. Preliminary evidences suggest that cognitive behavior therapy when combined with hypnotics or promoting agents has been found more effective. However, more systematic research is required in the future in this area.

Headache secondary to sleep-related bruxism: A case with polysomnographic findings.

Sleep-related bruxism may present with headache. However, in clinical practice it may be difficult to differentiate from other causes of headache, especially in subjects with substance abuse. We are presenting a case of sleep-related bruxism that presented with headache and sleep-related symptoms in the presence of substance abuse. Polysomnography was used to ascertain cause of headache. How the other possible causes of headache ruled out is also discussed in report. In short, Sleep-related bruxism can cause headache that is worse in the morning. It is associated with poor quality sleep.